Healthcare Provider Details

I. General information

NPI: 1104061704
Provider Name (Legal Business Name): IMRAN MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

2910 ARTESIA XING
URBANA IL
61802-6923
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-7921
  • Fax: 317-415-7922
Mailing address:
  • Phone: 315-350-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01089105A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01089105A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336.097347
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: